Long-Term Prognostic Value of Infarct Transmurality Determined by Contrast-Enhanced Cardiac Magnetic Resonance after...

Area of Science:

• Cardiology
• Medical Imaging

Background:

• The long-term prognostic value of maximal infarct transmurality in ST-segment elevation myocardial infarction (STEMI) using contrast-enhanced cardiac magnetic resonance (CE-CMR) remains unclear.
• Established CE-CMR predictors in STEMI include microvascular obstruction (MVO) and intramyocardial hemorrhage (IMH).

Purpose of the Study:

• To determine if maximal infarct transmurality offers additional long-term prognostic value in STEMI patients beyond MVO and IMH.
• To assess the association between maximal infarct transmurality and major adverse cardiac events (MACE) in STEMI patients.

Main Methods:

• 112 STEMI patients underwent CE-CMR post-infarction to evaluate infarct transmurality, infarct size, MVO, and IMH.
• Major adverse cardiac events (MACE), including death, reinfarction, and heart failure hospitalization, were tracked over a median of 7.9 years.
• Stepwise multivariable Cox regression analysis was used to identify independent predictors of MACE.

Main Results:

• 10 MACE occurred during follow-up.
• Patients with MACE showed significantly higher rates of transmural extent of infarction, infarct size >5.4%, MVO, and IMH.
• Maximal infarct transmurality (≥75%) independently predicted MACE (HR 8.7, P=0.043) after adjusting for MVO and IMH.

Conclusions:

• Post-infarction CE-CMR-based maximal infarct transmurality is an independent long-term prognosticator in revascularized STEMI patients.
• Incorporating maximal infarct transmurality into CE-CMR assessments can improve identification of STEMI patients at high risk for adverse long-term outcomes.